The Centers for Medicare and Medicaid Services (CMS) released the final physician fee schedule rule for Calendar Year (CY) 2012, which sets the therapy cap on outpatient services (except outpatient hospital departments) at $1,880 beginning January 1, 2012. The therapy cap exceptions process will expire on December 31, 2011, unless Congress acts to extend it.
The final rule calls for a 27.4% cut in Medicare payments—less than the 29.5% cut estimated earlier this year—for physicians, physical therapists, and other health care professionals based on the flawed sustainable growth rate formula (SGR). However, if Congress intervenes before the January 1, 2012, effective date, the aggregate impact of work Relative Value Units (RVU), practice expense RVU, and malpractice RVU changes for 2012 on physical therapy services is a positive 4% (noted on Table 84 on page 1176 of the rule). According to CMS, the Obama administration is "committed to fixing the SGR and ensuring these payment cuts do not take effect."
CMS also will make changes in how it adjusts payment for geographic variation in the cost of practice. The agency is replacing some of the data sources—such as using data from the American Community Survey (ACS) in place of the Department of Housing and Urban Development (HUD) rental data and also using ACS data in place of the data currently used for non-physician employee compensation. CMS also will adjust its payments for the full range of occupations employed in physicians' office and will make other adjustments called for in prior year public comments.
The CY 2012 final rule also updates or modifies several physician incentive programs, including the Physician Quality Reporting System.
APTA will post a detailed summary of the final rule next week.
This article was updated November 4 to reflect when APTA's summary will be available.